Why are there defaulters in eye health projects?

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Abstract

PURPOSE: To identify barriers to attendance for eye examination of schoolchildren. METHODS: Cross-sectional study. Students in grades 1-4 in elementary school in Guarulhos (Brazil) were screened and referred for ophthalmic examination in 2006. Facilities offered in this project were: examination arranged during weekends, free transportation, spectacle donation and two different opportunities for exam. A questionnaire was applied, by interview, to a sample consisted of students' parents attended in a community project who missed the first call and attended the recall, to identify the reasons for non-attendance. RESULTS: The sample consisted of 767 parents or guardians, corresponding to an equal number of schoolchildren. Personal characteristics of the students: 49.2% male and 50.8% female, 60.2% of them had never received previous ophthalmologic evaluation. Reported reasons for no-show to the project: parents had not received appropriate orientation (35.6%), loss of working day (20.6%), illness (12.4%), had another appointment (10.0%). The need for eyeglasses was higher in the recall. CONCLUSIONS: A significant number of parents did not take their children for ophthalmological exams, even when a second opportunity was offered in projects with transportation facilities, free exams performed during weekends and spectacle donation. The main causes of absenteeism were lack of awareness and work. For 87.1% of the absenteeism cases, the difficulties could be overcome via improved structuring of the first call. A recall increases attendance coverage of target population by only 15.2% (59.3 to 74.5%). Notably, the eye exam campaign was the first exam for most of the absent students.

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Global magnitude of visual impairment caused by uncorrected refractive errors in 2004

Serge Resnikoff, Donatella Pascolini, Silvio Mariotti … (2008)

Estimates of the prevalence of visual impairment caused by uncorrected refractive errors in 2004 have been determined at regional and global levels for people aged 5 years and over from recent published and unpublished surveys. The estimates were based on the prevalence of visual acuity of less than 6/18 in the better eye with the currently available refractive correction that could be improved to equal to or better than 6/18 by refraction or pinhole. A total of 153 million people (range of uncertainty: 123 million to 184 million) are estimated to be visually impaired from uncorrected refractive errors, of whom eight million are blind. This cause of visual impairment has been overlooked in previous estimates that were based on best-corrected vision. Combined with the 161 million people visually impaired estimated in 2002 according to best-corrected vision, 314 million people are visually impaired from all causes: uncorrected refractive errors become the main cause of low vision and the second cause of blindness. Uncorrected refractive errors can hamper performance at school, reduce employability and productivity, and generally impair quality of life. Yet the correction of refractive errors with appropriate spectacles is among the most cost-effective interventions in eye health care. The results presented in this paper help to unearth a formerly hidden problem of public health dimensions and promote policy development and implementation, programmatic decision-making and corrective interventions, as well as stimulate research.

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Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India

Vilas Kovai, Sannapaneni Krishnaiah, Bindiganavale Shamanna … (2007)

Purpose: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. Materials and Methods: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. Results: Of the eligible subjects, 1234 (22.1%, N=5573)) presented with distant visual acuity < 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234) subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90) and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03). Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%. Conclusion: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.

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Barriers to spectacle use in Tanzanian secondary school students.

Nita Odedra, Susanne H Wedner, Zachayo Shigongo … (2015)

Screening school students for refractive errors is a component of many primary eye care programs. In 2004 a trial of two approaches of spectacle-delivery to Tanzanian secondary school students found that only one third of students were using their spectacles at three months. Barriers to spectacle use were investigated using questionnaires and focus group discussions. At the three months follow-up survey a questionnaire explored satisfaction with spectacles and the attitudes of trial participants (median age 15 years). Attitudes and reactions of friends, teachers and families were also explored. Students also discussed their experience with spectacle use and reasons for non-use in 8 focus groups divided by intervention, sex and spectacle use. In general, students seemed happy with the appearance of their spectacles and the beneficial impact on their vision. Peer pressure and parental concerns about safety of spectacle use, cost of purchasing spectacles and difficulties in accessing good local optical services were identified as the main barriers. Students criticized prescribing practices of local opticians and favored alternative and traditional treatments for visual impairment. To increase the effectiveness of school vision screening in Tanzania, barriers such as peer pressure or concerns about safety need to be addressed, in addition to provision of affordable, good quality spectacles. Barriers to spectacle use in children are likely to exist in all populations, but may vary in their nature and importance and therefore should be investigated in existing and new screening programs.